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tv   Book TV  CSPAN  March 25, 2012 2:00am-2:30am EDT

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>> i heard it said if you put a group of liberals in a room this you will go to the extreme liberal and conservatives will also. going to the edges. use the any of that in the end of flow with the makeup conservatives in the room they go to the extreme does that have been today? >> not on the liberal side. i will tell you that.keup of the opinions with a history of the supreme court? >> liberals and conservatives in the room they go to the extreme does that have been today? >> not on the liberal side. i will tell you that. nobody on the court today like justice brennan or thurgood marshall who would
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think of the constitution to be harnessed for social progress. the liberals on the court court, have been playing defense for a long time. we'll speak for the majority but it relates in part to the personalities of theersonale individuals but somebody who has steeply progressive groups is not likely t the personalities of the individuals but somebody who has steeply progressive groups is not likely these days to get nominated or confirmed. . . etch for joining
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us. appreciate it. guest: thank you. host: now we turn our attention to the new healthcare bill that was passed into law recently. joining us at the table is alice mcgillis of "the washington post" here to talk about also a new book, "the washington post" put out a book "inside story of america's new healthcare law" and what it means for us all. you can see my notes here. there are a couple of stories this morning in the paper about the latest on this healthcare
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bill. this is one from the "washington post" -- 18 states decline to run high-risk insurance pools. what's going on? guest: this is one of the first provisions in the bill that we're setting up high-risk pools across the country, a temporary thing, sort of a bridge to get us to the main provision of the bill which goes in effect in 2014. people who have pre-existing conditions who are in big trouble because they can't get plans they are going to be able to go into the high risk pools that are being set up. this will be a a temporary stopgap until 2014. starting in 2014, insurers will have to take these people. the high risk pool will probably be a problem. it's going to be tricky to set up. there may not be enough money for it. some states are already resisting setting them up in their states. host: 18 states are declining right now. guest: yes. host: states are concerned that if funds run out there could be difficult choices, political choices, reducing benefits, raising premiums or limiting
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enrollment. guest: right. this is really kind of a -- this problem is because they waited until the 2014 to implement the main parts of this law, so they had to find a way to take care of people in the worst off positions until then. this is not an ideal solution. basically what you're doing is taking the sickest people and putting them into a pool which is not the way insurance is supposed to work. on top of that, you have some of these states that are ropesed to this bill saying we're not going to cooperate. this could get messy. host: alec mcgillis is one of the coauthors of this book "inside story of the america healthcare law" and here to talk about what it means and what does it mean for doctors, hospitals, medicare. start dialing in now. the phone numbers will be on your screen. lots of questions about the impact of this. let's start with doctors, what does it mean for doctors first? guest: doctors -- it's
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interesting. doctors are going to see this impact but not as much impact as maybe people thought they should have. this law did not do as much as it could have to take on sort of the cost problems on the provider side for the cost problems that we're facing among hospitals, doctors, drugmakers. really the law is more focused on the insurers, and so doctors are going to see some sort of more peripheral impacts. there is going to be more money for doctors who want to go into primary care, more money to help them with their medical loans and whatnot. they are going to be encouraged over are time to change the way they work to get into networks basically where they're working together instead of small practiced, working more on a salary rate instead of fee for service which is the way most of our healthcare is delivered now. in a lot of ways, doctors partly because they have such a
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powerful lobby in washington really avoided a more direct impact than they could have had. host: the story today in "the washington post" featuring the book says there is going to be an an emphasis on primary crare. guest: yes. there is a big concern that when you expand coverage as we do in this bill, that you will have a lack of access to primary crare, more people coming into the system and just not enough doctors to go around, and so the bill does provide a substantial amount of money to encourage doctors to go into primary care to go into served and underserved areas, and again, that's not really the main thrust of the bill. host: for doctors, a big concern was reimbursement, medicare reimbursements. here is a tweet "hhs published medicare broke in 2016. boomers at 65 at 40% to the number of seniors and the health
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bill cuts $50 billion. what will be cut? " the cuts in medicare, there is a lot of concern about this obviously during the debate. the cuts in medicare are really -- and they were agreed to by the hospitals and doctors. they come to about $150 billion over the first ten years calling them cuts is a bit of a misnomer. every year doctors will get more from medicare to account for inflation and the rising costs. this he are now agreeing to a smaller increase in the medicare reimbursement than they would have otherwise got they agreed to this because they realize fire department they didn't, they would take a bigger hit. this was their deal to avoid the public option. doctors and hospitals assumed the insureds were opposed to of
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government run option. in fact, it was the doctors and hospitals who were just as opposed to it because it would lead to lower reimbursements in all likelihood. host: a lot of questions out there, a lot of debate about what the healthcare bill will do. alec mcgillis is co-author of a new book, and mark on the republican line, you're our first phone call, go ahead. hello, this is sheila. host: go ahead, sheila. caller: our insurance commissioner, osmgen hediner said he sent a letter to kathleen sebelius saying that georgia would not participate. i'm one of those people that needs insurance because of preexisting conditions. is there -- is the federal government going to take that
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over? guest: yes, sheila. you're right. he was the first commissioner to come out and say he would not go along with the high-risk pool in his state, sort of another aspect of the states' rights opposition we're seeing in a lot of states which has mostly taken, manifested itself in people saying they're going to sue about this mandate that's in the law, the mandate that everyone carry insurance. when the insurance commissioner came out and said he would not help in setting up the high-risk pooght, kathleen sebelius said the federal government would be able to do that for the state, that there is a provision in the law that high-risk pools, states will not be left without them just because their state is refusing to cooperate. there is going to be everyone more of a problem with states not being cooperative when it comes to the really big part of the law in 2014 when we start setting up the newmarket places called exchanges that the states
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have to set up where people buy insurance. if states are are brie grudging and opposed to this law, that will be a tremendous problem. they are simply not helping to set up good exchanges in the state. host: mark on the are republican line from boston. go ahead. caller: if the federal government forces the states to violate their religion beliefs by violating the free expression clauses of the united states constitution by forcing states to fund abortion and federal government is breaking the tenth amendment. host: what about the abortion provision? there is great uncertainty of how this will play out a lot of people think it is quite possible that it is actually going to be libel abortion coverage provided in these plans offered on these new
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exchanges. the language we ended up with is that companies can offer plans that include abortion coverage on these exchanges, on these marketplaces where we're going to buy insurance, but people who buy into those plans are going to have to write separate checks, make separate payments every month for their premiums, one to go to the bulk of their coverage, and then a very small payment like a dollar a month or something to go towards the abortion coverage a lot of people think this is going to be so unwieldy for the inshiewrpers to implement and a lot of people will think this is crazy. why do have i i have to write for checks for my insurance plan. everyone buys into these plans will have to write separate checks for abortion coverage. there may not be a market for these plans. the people will think it is wierd and unappealing. it is actually quite possible that you're going to see little abortion coverage in these plans. it is worth noting that most private insurance plans today do include abortion coverage. lots of people don't realize it but chances are from you are
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getting coverage through your employer, that coverage may very well include abortion coverage. host: another tweet from gun toting dem says where is the list of the rogue 18 states? i want to call their governors." are these states able to opt out of high-risk pools? guest: they can't op ochts out. the federal government is able to set up the pools. the bigger question is whether they will work. they set aside $5 billion over the next four years until the main parts of the bill go into effect. a lot of people think that's not enough money. right now, some states already have high-risk pools on their own and we're spending about $2 billion a year to cover 250,000 people. $5 billion over four years probably ain't going to cut it. it is not an ideal way to be helping these people in this
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interim period. there is a reason why this is not the permanent solution. it is not a very good solution. host: buzz on the democratic line. good morning. caller: thanks for c-span. good morning. first of all, i was curious about the tax credit that i see, you know big industry are receiving. for an individual like myself that purchases my own insurance, i wondered if i would get a tax credit for the premiums that i pay, because my employer doesn't supply insurance or provide it. also, i wondered why the delay was implemented, because it seems like these states are juxtaposing themselves against the bill. also, i wondered if it is an insurance giveaway and how will it affect pharmaceuticals. guest: to start off on the tax credit, you make a good point. people who buy insurance on their own have to pay for their
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insurance on a post-tax basis. you don't get that benefit that people do when they get insurance through their employers but the idea with this new law is that you are going to -- you're still going to be paying with after-tax dollars but if your income is below a certain level, you're going to get help to buy your insurance. it is a recognition that you're kind of getting -- not getting shafted a little bit in the existing tax structure. you're going to be gebtsing a subsidy that people who get insurance through their employer are not going to be getting. i'm not sure what your income is, but families up to $88,000 a year of income are going to be getting subsidies to help them purchase insurance on a sliding scale going up to that many as to the question about the delay, one is that implementation will be a hassle to set this system up, set up the newmarket places so they had to give themselves
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time to implement it. another thing is they had to delay it to make the numbers work. by waiting on the main parts of this bill, they have also reduced the cost of the bill over the first ten years of the bill, and so there is a little bit of funny number stuff going on there. finally on the pharmaceuticals, the drug industry made out pretty well in this bill. they were the industry that right from the start tried to get in to be at the able and to -- they paid a lot in ads supporting the bill, and they were very key supporters of it. in exchange, they basically got -- avoided some of the things they were most worried about, such as reimporting drugs from canada and also letting medicare buy drugs in bulk for their medicare drug benefits. the one thing drug companies did concede basically which will
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help people is that there is the doughnut hole in the medicare drug benefit that a lot of seniors have to deal with and don't like is going to shrink. seniors will get a $250 check in the upcoming weeks, seniors who go into that doughnut are getting a check to sort of help them with that problem right off the bat. host: carol, independent line, you're on the air. caller: good morning. it's nice to see you. i'm curious about all the people who call in about they don't want their taxes going towards abortions. they're so afraid of this, but they take my taxes all the time for a war that i'm morally opposed to, and i'm wondering how they can justify that anything and if they have an argument that would hold up. host: do you have a question about the implementation of this law? are you curious about anything?
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caller: i'm curious about so much. i'm wondering how these people think they can get out of paying taxes because they think some of it might be going toward abortions. host: yes, we got your point. alec mcgillis is a healthcare reporter and can't answer that question. eddie on the republican line. go ahead. caller: i don't consider it reform at all. i think it is more of the same. that's all we're going to do is just insure more people. we're nation of litigants. we have twice as many lawyers as we have doctors. we're just going to have three times as many lawyers as doctors. the beauty of europe is that a doctor in a hospital is sacro sanct. you don't bite the hand that feeds you. don't go there and sue them, please. host: what about tort reform? guest: you're right. there is some language raring
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tort reform. i think about 25 million or $250 million to encourage states to head up some new pilot programs to deal with the problem of malpractice, concerns about malpractice. you know, and just beyond that, you said that you don't see this bill as reform, there are a lot of people that think that's really true in a broader sense, that this bill did a lot to cover the 40 million americans that don't have coverage but didn't do enough on the side of reducing costs, not just, you know malpractice issues for people who think that is a cost driver, but really beyond that, there is a lot in this bill to try to get us to use healthcare less, to reduce our utilization in healthcare and wasteful use of healthcare, but there is not a lot to reduce the price we pay for healthcare, the price we pay for all the things we get when we go to the hospitals.
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host: bill on the democratic line. caller: i'm interested in looking at your book and reading it. i would also like to ask all the people that call in all the time and say that the government can't force them to buy insurance, does that mean that if i was in a car accident with their wife and child they can reach in their glove compartment and pull out $50,000 and give it to the hospital when they arrive? guest: this is one of the big questions of this law, what people are going to make of the mandate that everyone has to have insurance. this is at the heart of the law, this idea that we're basically making insurers to behave better to cover everyone to stop doing some of the things we don't like n exchange for that, they will get all these new customers because we require people to have insurance, the idea being if you don't get insurance then you're shifting the cost to everyone when you do get sick. the argument against the mandate is, well, yes, with car
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insurance i got to get insurance but i don't have to buy a car. here you're saying if i'm human, i have to get insurance to cover my health and myself, but from a sort of the implementation of this law and from the way it's supposed to function, it is really going to be important that the mandate work, and that people don't find ways to skirt it and just pay the penalty. the penalty is not very big. a lot of people may pay the penalty to get out of it and if they do that and a lot of people don't get insurance, the law really may not work because you will then have insurers basically having to cover older, sing sicker people without the benefitting of having younger, more healthy people in the pool that. is the only way this can work is if you get everyone into the pool. host: when is the deadline for insurance companies to start accepting young adults on to their parents' insurance? guest: that is in the coming
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months that. is one of the early provisions you can stay up to 2 6, which is a big deal for families. the biggest provision, the one that says it all, everyone including young people have to have insurance, that doesn't go in effect until 2014. host: some insurance companies have started to accept young adults on their parents' insurance. guest: they have, for ease of a transition, they just started doing it already. that is definitely a tangible benefit for a lot of people right there. host: helen on the independent line. caller: i wanted to know do you have a handle on how many new bureaucratic agencies are created by this bill? guest: good question. the main agencies that are going to be implementing it really are the ones we have now, our health and human services department, medicare and medicaid
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department, the actual exchanges that i keep referring to, these marketplaces where you're going to go to buy insurance if you don't get it through your employer, they're going to be sent up on a state by state basis or regional basis. it will be up to the states to set these things up which could be a problem in states that the political leadership doesn't like the bill and it won't be moabts straighted to make it work. in massachusetts, which really passed a model of this bill back in 2006, it took a lot of effort to get their version of the exchange working. that was the state where you had bipartisan political support around the bill including the then governor mitt romney, are republican, who signed the bill, this real consensus around it and everyone was onboard to make it work. now you're going to try to do it in states like texas, arkansas, alabama, georgia, states that, a, just don't have much insurance regulation right now at all. that's just not something that
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they do very much of and don't have much capacity for, but also where there will be a real political resistance for doing this. that will be more of a bureaucratic concern than the bureaucratic load at the federal level. host: this viewer is asking do you think insurance companies will offer multi-family discounts since there is a mandate to have insurance? will this create a new market? guest: well, yes, that's sort of the premise that you're requiring people to have insurance, you're going to get more people into the pool. that is really the idea here. right now, the problem somebody that people who try to buy insurance on their own have a really hard time of it, a, because in some states insurance companies can reject someone with a preexisting condition or charge for their time. and b, the rates are very high because the pool is not big enough. you only have people in the pool who really think they need insurance, so it doesn't really
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work the way that insurance is supposed to would work, so the s that you will create this healthy, busy thriving private sector marketplace, and eventually if it works, the long-term hope is that you will get more of us going into these exchanges over are time. they might become the base of our insurance system, not employer had-based coverage. host: shirley on the republican line. caller: good morning, everywhere i go and i go to a lot of the tea parties, i hear a lot of senior citizens complaining that they paid into this system all their life and now they have to worry about medicare, are we going to lose our medicare? they keep saying how much money is going to be taken out of medicare. people are upset about this. host: what are the facts? guest: it is more complicated than that. the impact that a medicare recipient is going to see,
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negative impact is, if they are people who are in medicare advantage plan, which are the plans that are run by hmo's by private insurers who get money from the government to provide medicare-like product to seniors. these plans are getting their subsidies cut, so the companies that offer these plans are getting less money from the federal government to offer the plan, so they might stop offering the plans or might make the plans less appealing by cutting out some of the benefits that come with theme like free gym memberships, that kind of stuff. people with medicare advantage plans might feel the pinch. the real hope is for medicare generally that possibly doctors are getting slightly lower reimbursements over time than they would have, but they will have to find ways to deal with that and some of the other reforms in the bill that are meant to change the way we deliver care and change the ways we deliver care that is more inefficient, the hope is that
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the reforms will help them deal with the medicare services. finally, i'm not sure if you have to deal with the doughnut hole problem. a lot of people do. that problem is going to go away with this bill over the next few years. that will shrink not to nothing but almost nothing. host: democratic line from richmond, virginia. go ahead, sir. caller: my comment is more in line for being a question, and i understand that the states want to sue the government on that they don't have to be mandated or not to be mandated. my question is if the citizens of that state want to participate, can the citizens sue the state? guest: good question. in a sense, the best response for a citizen of one of these states where the political leadership is not being co
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